I am aware that participation in Ballet/Pointe classes and activities at Little House Dance Studio could involve some possible personal injuries. Despite precautions - accidents and injuries may occur. By signing this form, I understand and agree that Little House Dance Studio will not be liable in any way for injuries or medical expenses incurred by myself/my child during attendance at Little House Dance Studio or any related activity associated with Little House Dance Studio.

Furthermore, I grant Little House Dance Studio the authority to authorize any emergency treatment that may be required for myself/my child during classes.

I am aware that participation in Ballet/Pointe classes and activities at Little House Dance Studio could involve some possible personal injuries. Despite precautions - accidents and injuries may occur. By signing this form, I understand and agree that Little House Dance Studio will not be liable in any way for injuries or medical expenses incurred by myself/my child during attendance at Little House Dance Studio or any related activity associated with Little House Dance Studio.

Furthermore, I grant Little House Dance Studio the authority to authorize any emergency treatment that may be required for myself/my child during classes.


I have read and understand the above waiver/authorization

I hereby grant permission for video recording and/or digital photos to be taken of the above-named dancer by Little House Dance Studio.

I authorize Little House Dance Studio to use my child's image on its website, social media sites and/or printed promotional materials without further consideration and I acknowledge Little House Dance Studio's right to treat the media (such as cropping) at its discretion.

Note: No names will be identified unless further permission is granted from parent and/or guardian.